Transjugular intrahepatic portosystemic shunting (TIPS) is an artificial channel within the liver that establishes communication between the portal vein and the hepatic vein. TIPS is sometimes used to treat portal hypertension that is often due to liver cirrhosis, which frequently leads to intestinal bleeding, esophageal bleeding and the build up of fluids within the abdomen. The TIPS procedure works by gaining access to the liver via the jugular vein, and then moving through the vena cava to the hepatic vein. A needle is then used to create a point of access (shunt) from the hepatic vein through the liver tissue into the portal vein. A guide wire is introduced to maintain access, and then a balloon catheter is placed over the wire and into the liver tissue. The balloon is inflated in the shunt to create a conduit that will accommodate the forthcoming stent. The balloon is deflated and removed. A stent introducer is then inserted and the portal end of the stent is deployed. The rest of the stent is then released and the balloon is reinserted and reinflated to assure that the stent is fully patent. The stented shunt allows for pressure relief in the portal vein, and blood can return to mostly a normal path through the liver, and therefore reduce some of the symptoms described above.
There are a variety of problems associated with the current TIPS procedure. One problem is that the stent length and sometimes diameter needed for a patient is uncertain, even with careful measuring and estimation. Physicians would like to control the length and diameter of the stent during and post-procedure. For instance, due to substantial variations among patients' internal anatomy geometry, stent sizing can require that a hospital maintain a wide variety of stent introducers with stents of varying lengths to accommodate all potential patients. In addition, when it is necessary for the physician to complete the procedure with the implantation of two stents, the first stent introducer must be withdrawn and a second stent introducer must be brought into the patient, increasing costs, procedure times and complication risks to the patient. An additional problem is that this procedure is expensive due to physician operating time and materials. Lastly, a covered stent is often integral to the procedure, and physicians generally prefer longer sleeve covered stents. These covered stents have an outer coating that keeps bile out of the shunt, and may include an inner coating that promotes platelet growth and blood flow. European patent application EP 1044663A2 is of interest for teaching a sleeved intrahepatic endoprosthesis (stent) in which two members can be connected telescopically to adapt to the length of stenting required for a particular patient. However, this reference teaches mounting the two stent members on separate delivery devices requiring withdrawal of the first delivery device before the second stent can be implanted using a second delivery device.
The present disclosure is directly toward one or more of the problems set forth above.